Anesthesia For C-Section In Parturient With Pulmonary Hypertension And ESRD

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Medically Challenging Case Report Poster 


Ravi Shah  
Stony Brook University Hospital


Ramon Abola  
Stony Brook University Hospital


35 year old female G3P2 with a history of severe tricuspid and mitral valve regurgitation, pulmonary hypertension, ESRD on hemodialysis, and admitted for fluid overload, underwent cesarean section due to fetal biventricular hemorrhage at 29 weeks gestation. Multidisciplinary management included achieving euvolemic status prior to surgery, intraoperative arterial line, central access, vasopressor availability and lumbar epidural catheter placement. VA ECMO groin lines were placed before her surgery in case of sudden decompensation. The patient remained hemodynamically stable and the baby was successfully delivered with transfer to NICU. This case identified the many challenges faced managing a very high risk obstetric patient with several comorbidities.

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Enter up to two references.

1. Martine Bonnin, Frédéric J. Mercier, Olivier Sitbon, Sandrine Roger-Christoph, Xavier Jaïs, Marc Humbert, François Audibert, René Frydman, Gérald Simonneau, Dan Benhamou; Severe Pulmonary Hypertension during Pregnancy: Mode of Delivery and Anesthetic Management of 15 Consecutive Cases. Anesthesiology 2005;102(6):1133-1137.